Coronavirus surges show worst is yet to come

Surging coronavirus cases across the country are threatening to explode into new epicenters as the hard-won progress earned by months of painful lockdowns unravels into a summer of lost opportunity.

More than 4 million people in the United States have tested positive for the SARS-CoV-2, and 140,000 have died. 

After wrestling the virus down to as few as 17,000 new cases a day in the first days of June, the daily case count has surged to heights even greater than those reached in the worst days of March, April and May. The United States has averaged 66,000 cases a day in the last week, its highest seven-day average and twice as high as the average in late June.

Across the nation, more than 59,000 people are in hospitals being treated for COVID-19, the disease caused by the coronavirus. More than 1,000 Americans have died on each of the last two days, a threshold not reached since late May.

A month ago, about 30,000 Americans were in hospitals, and the country was averaging more than 500 deaths a day.

“Hospitals now are back in the same territory that they were at their peak in April,” said Jeremy Konyndyk, who ran USAID’s Office of Foreign Disaster Assistance and is now a senior fellow at the Center for Global Development. “That will almost certainly continue to go up for the next few weeks, because the number of cases is up.”

President Trump, who spent months downplaying the severity of an unprecedented virus, acknowledged Tuesday that the worse of the pandemic is yet to come. 

“Some areas of our country are doing very well; others are doing less well,” said Trump, who finds himself badly trailing presumptive Democratic nominee Joe Biden largely because of disapproval of his handling of the pandemic. “It will probably, unfortunately, get worse before it gets better — something I don’t like saying about things, but that’s the way it is.”

There are signs that physicians are getting better at treating the novel pathogen, and that more widespread testing is identifying cases that earlier would have gone overlooked. The share of people who test positive and die has fallen.

But the number of daily dead and the number of people who require hospitalization for treatment are lagging indicators, and both threaten to rise as case counts multiply. Those who are diagnosed today may not require hospitalization for two more weeks, and those who are hospitalized might not die for another two weeks.

Konyndyk warned that the number of hospitalizations and deaths will not plateau or begin to decline until weeks after the number of cases begins to drop. Today, they are still on the rise across the country. 

The pandemic landed in just a few epicenters — New York, Seattle and San Francisco — at the beginning of this year, and numbers have eased in those early hot spots. There also are hopeful signs that the worst is past in newer epicenters like Phoenix and Houston.

But Americans traveling during the summer months, letting their guard down and abandoning social distancing practices has meant new embers are erupting into conflagrations elsewhere. Models from the PolicyLab at the Children’s Hospital of Philadelphia — which correctly predicted the Phoenix and Houston outbreaks — now point to emerging outbreaks in Indianapolis, Denver, Baltimore and Chicago.

The White House’s coronavirus task force warned in a call with state and local leaders Wednesday that 11 cities are seeing a worrying spike in the percentage of tests that are coming back positive. 

Deborah Birx, leading the task force, said those cities — Baltimore, Cleveland, Columbus, Indianapolis, Las Vegas, Miami, Minneapolis, Nashville, New Orleans, Pittsburgh and St. Louis, as first reported by the Center for Public Integrity — must take “aggressive” steps to control outbreaks that could soon erupt.

Daily case counts show a nation in the grips of the coronavirus: The average number of new cases confirmed on a daily basis has risen by at least 50 percent over the last two weeks in 15 states. New cases have fallen in only seven states. The number of people being treated in hospitals has risen in 33 states, according to data released by state health departments.

A report to the coronavirus task force, also published by the Center for Public Integrity, warned 18 states are in a “red zone” in which the virus is spreading unchecked.

“It’s not just a couple of major hot spots now. We’ve got a problem in the whole country,” Konyndyk said. “We have to turn the curve around. We are in an extremely bad place nationwide.”

The models show that even New York City is at elevated risk of resurgence once again, and that states in New England, so far the only bright spot in the country, will see their numbers rise in the coming weeks.

In a study published in the Journal of the American Medical Association, PolicyLab researchers found that basic social distancing measures were effective in reducing transmission of the virus, even in densely populated areas. An increasing number of governors and mayors are requiring residents to wear masks in public settings, after studies showed that even simple cloth masks drastically reduced transmission.

“I can only hope that reticent leaders who have not yet regained control of spiking cases in their own communities will realize that universal masking policies need to be combined with smart sensible approaches to social distancing, like reducing gathering sizes and bar closures, to stop the continued surge of this virus,” said David Rubin, director of the PolicyLab. “Otherwise, we’re threatening our ability to regenerate our economy this fall and protect the health of children and families in advance of what could be a difficult fall and winter season.”

Public health experts are increasingly concerned about so-called super spreader events, where just one infected person can infect dozens — in rare cases hundreds — of others in tightly packed spaces where social distancing is not possible and that lack airflow. Almost universally, those health experts want local and state officials to order bars and restaurants to close.

“A lot of states are still making poor policy decisions. Bars should be closed, indoor dining in restaurants should just be shut,” Konyndyk said. “There is no universe in which bars should be opened before schools.”

The true number of those who have been infected is likely far higher than the official count of confirmed cases. Another study published in JAMA by researchers at the Centers for Disease Control and Prevention, who examined blood samples in 10 regions across the country from late March to early May, found that the true number of infected people was likely more than 10 times greater than the number of reported cases.

Other nations that enforced strict lockdowns have staged remarkable, if predictable, comebacks by religiously observing the sorts of social distancing guidelines that are proven to work, keeping the number of new cases down to a manageable toll. 

Italy, the epicenter of the global pandemic in late March, reported 1,526 new cases in the last week, fewer than half the number of cases Alabama alone reported on Wednesday. South Korea, the first nation outside of China to experience a significant outbreak, reported 326 new cases in the last week, about a third of the number the state of Indiana reported on Wednesday.

The U.S., in contrast, is home to more than a quarter of the 15.3 million cases confirmed worldwide, and to almost a quarter of the 624,000 people who have died.